Laparoscopic adhesiolysis

Summary

Laparoscopic adhesiolysis is a keyhole operation to divide adhesions — bands of internal scar tissue that can form after previous surgery, infection or endometriosis, and can bind organs together, causing pain, bloating, bowel symptoms or fertility problems.

• Done through 2–4 small keyhole cuts under general anaesthetic; usually home the same or next day.
• Often combined with another procedure — a dye test, cystectomy or endometriosis surgery — in the same sitting.
• Most women recover to normal activity within 1–2 weeks.
• Honest caveat: adhesions can re-form after any surgery, including this one — the decision to operate weighs likely benefit against that reality.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

Adhesions are the body's internal scars: after an operation, infection (such as pelvic inflammatory disease or appendicitis) or endometriosis, healing surfaces can stick to each other, forming bands between the bowel, womb, tubes, ovaries and abdominal wall. Many cause no trouble; some pull on organs, kink the bowel, or fix the pelvic organs so movement hurts.

At laparoscopy the surgeon divides these bands with fine instruments under magnification, freeing the organs and restoring normal anatomy where possible. Care is taken to handle tissue gently and keep surfaces moist — the techniques that best limit new adhesions forming. An adhesion barrier may be placed at the end.

Why it is performed

• Chronic pelvic or abdominal pain attributed to adhesions after other causes have been assessed
• Fertility problems — adhesions distorting the tubes and ovaries; often found and treated at a laparoscopy and dye test
• Recurrent partial bowel obstruction from adhesion bands
• Access — freeing adhesions is often the necessary first step of another planned operation

Benefits

• Pain relief for well-selected women whose pain comes from adhesions.
• Restored anatomy — tubes and ovaries freed, which can improve natural fertility.
• Diagnosis — the laparoscopy itself confirms (or rules out) adhesions as the cause of symptoms.

Alternatives

• No surgery — pain management, physiotherapy and treating other contributors; reasonable when adhesions are suspected but symptoms are manageable.
• IVF — where the issue is fertility with badly damaged tubes, IVF may offer a better chance than adhesiolysis alone.
• Treating the underlying condition — endometriosis treatment where that is the driver.

Preparing for surgery

You will have ultrasound imaging and a review of your surgical history — previous operation notes are genuinely useful, so bring any records you have. Routine checks include blood pressure, blood tests where needed, and a review of your medicines. Tell the team about all medicines you take — blood thinners may need adjusting.

• Fasting: typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange someone to take you home and help for the first few days.

The day of surgery

You are admitted on the day of surgery. The team confirms your identity and the plan — including what should be done if extensive adhesions or unexpected findings are encountered. You meet the anaesthetist and surgeon and sign the consent form. You can still change your mind at this point. Compression stockings are usually fitted.

During the operation

Under general anaesthetic the abdomen is inflated with carbon dioxide gas — entry is made with particular care when adhesions are expected near the navel, sometimes through an alternative entry point. Working under magnification, the surgeon divides the adhesion bands with scissors or fine energy instruments, frees the bound organs, checks the bowel carefully, and may place an adhesion barrier. The operation takes from 30 minutes to a few hours depending on extent.

After the operation

• Shoulder-tip pain from the gas for a day or two is common and settles.
• Pain relief: regular simple painkillers control most discomfort.
• Moving and eating: up and about and eating the same day in most cases.
• Going home: usually the same or the following day; longer if the surgery was extensive.

Recovery at home

• Week 1: rest with gentle activity; short walks; avoid heavy lifting.
• Weeks 1–2: most women return to routine work and normal activity.
• Improvement in pain can take some weeks to judge fairly — keep your follow-up appointment, where findings and photographs from the surgery are usually reviewed with you.

Risks and complications

The main risks relate to operating close to bowel that is stuck where it should not be — which is also why this surgery needs experienced hands.

Expected, temporary effects

• Shoulder-tip pain, bruising around the cuts, tiredness for a few days

Complications

• Bowel injury — the signature risk of adhesiolysis; recognised injuries are repaired, and you are watched for delayed signs (uncommon, higher with dense adhesions).
• Injury to bladder, ureter or blood vessels (rare).
• Adhesions re-forming — possible after any abdominal surgery; symptoms can return (common over the long term).
• Incomplete relief — pain has many causes; dividing adhesions does not guarantee cure.
• Conversion to open surgery for safety (uncommon).
• Infection, bleeding, blood clots, anaesthetic risks — as for any laparoscopy (uncommon to rare).

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• An offensive-smelling vaginal discharge
• A keyhole wound that becomes red, swollen, hot or leaks fluid
• Vomiting, a swollen abdomen, or inability to pass wind or stool — signs the bowel needs checking
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing you should feel you understand why this procedure is recommended for you, what the realistic alternatives are, and which risks matter most in your case. Print this checklist and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. Royal College of Obstetricians and Gynaecologists. Laparoscopy — patient information. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 12 August 2026].
2. National Institute for Health and Care Excellence. Chronic pelvic pain pathways and laparoscopic guidance. Available from: https://www.nice.org.uk/ [last checked 12 August 2026].
3. National Health Service (UK). Laparoscopy (keyhole surgery). Available from: https://www.nhs.uk/tests-and-treatments/laparoscopy/ [last checked 12 August 2026].